Clayton C Petro1, Sean B Orenstein2, Cory N Criss2, Edmund Q Sanchez2, Michael J Rosen2, Kenneth J Woodside2, Yuri W Novitsky2. 1. Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. Electronic address: Clayton.Petro@UHhospitals.org. 2. Division of Transplant Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Abstract
BACKGROUND: Incisional hernias in kidney transplant recipients (KTRs) can be complex because of adjacent bony structures, proximity of the allograft/transplant ureter, and context of immunosuppression. We hypothesized that our novel posterior component separation with transversus abdominis muscle release (TAR) and retromuscular mesh reinforcement offers a safe and durable repair. METHODS: KTRs with incisional hernias repaired using the aforementioned technique were identified within our prospective database (2007 to 2013) and analyzed. RESULTS: Eleven patients were identified (median age 49 years, body mass index 32). The median hernia size was 30 cm(2) (range 88 to 1,040 cm(2)) and 8 of the 11 patients were recurrent. Intraoperative morbidity consisted of one transplant ureter injury repaired primarily over a stent. Postoperative morbidity consisted of 2 superficial surgical site infections that resolved and 1 readmission for a blood transfusion. There were no instances of mesh infection, explantation, graft loss, or graft dysfunction. With a median follow-up of 12 months (range 3 to 69), 1 (9%) lateral recurrence has been documented. CONCLUSIONS: For complex incisional hernias in KTRs, TAR is associated with low perioperative morbidity and durable repair.
BACKGROUND: Incisional hernias in kidney transplant recipients (KTRs) can be complex because of adjacent bony structures, proximity of the allograft/transplant ureter, and context of immunosuppression. We hypothesized that our novel posterior component separation with transversus abdominis muscle release (TAR) and retromuscular mesh reinforcement offers a safe and durable repair. METHODS: KTRs with incisional hernias repaired using the aforementioned technique were identified within our prospective database (2007 to 2013) and analyzed. RESULTS: Eleven patients were identified (median age 49 years, body mass index 32). The median hernia size was 30 cm(2) (range 88 to 1,040 cm(2)) and 8 of the 11 patients were recurrent. Intraoperative morbidity consisted of one transplant ureter injury repaired primarily over a stent. Postoperative morbidity consisted of 2 superficial surgical site infections that resolved and 1 readmission for a blood transfusion. There were no instances of mesh infection, explantation, graft loss, or graft dysfunction. With a median follow-up of 12 months (range 3 to 69), 1 (9%) lateral recurrence has been documented. CONCLUSIONS: For complex incisional hernias in KTRs, TAR is associated with low perioperative morbidity and durable repair.
Authors: H Alkhatib; L Tastaldi; D M Krpata; C C Petro; M Olson; S Rosenblatt; M J Rosen; A S Prabhu Journal: Hernia Date: 2019-01-09 Impact factor: 4.739
Authors: L Tastaldi; J A Blatnik; D M Krpata; C C Petro; A Fafaj; H Alkhatib; M Svestka; S Rosenblatt; A S Prabhu; M J Rosen Journal: Hernia Date: 2019-02-21 Impact factor: 4.739
Authors: Gianluca Cassese; Antonio Castaldi; Bader Al Taweel; Moglie Le Quintrec; Rodolphe Thuret; Francis Navarro; Fabrizio Panaro Journal: Int Urol Nephrol Date: 2022-02-03 Impact factor: 2.370
Authors: K C Montelione; S J Zolin; A Fafaj; J D Thomas; C M Horne; K Baier; B C Perlmutter; S Rosenblatt; D M Krpata; A S Prabhu; C C Petro; M J Rosen Journal: Hernia Date: 2021-07-21 Impact factor: 4.739